Abuse of inhalants: a review

Butane-related deaths in post-mortem investigations: A systematic review

Volatile substance abuse is widespread among adolescents due to its easy availability and methods of consumption. Inhalant abuse represents a current problematic issue, causing significant morbidity and mortality due to direct toxicity on several target organs and displacement of gas which results in a lack of oxygen. This review aims to evaluate post-mortem and toxicological investigations in cases of suspected butane intoxication. We performed comprehensive research using the Preferred Reporting Items for Systematic Review (PRISMA) standards. Forty scientific papers fulfilled the inclusion criteria. A total of 58 cases of butane-related deaths were found. Among these, we found 11 cases of suicide (18%), 1 case of homicide (2%), 44 cases of accidental poisoning (76%), and 2 cases of work-related deaths (4%). Autopsy and post-mortem examinations were performed in 54 cases, whereas toxicological analyses were presented in 56 cases. In autopsy, pulmonary edema (51%) and poli-visceral congestion (59%) were the most common findings. When death by butane inhalation is hypothesized, autopsy and histological findings may be nonspecific, therefore toxicological investigations assume a crucial role along with attention to the methods used to collect biological samples.

The New Zealand drug harms ranking study: A multi-criteria decision analysis

AIMS

The harms arising from psychoactive drug use are complex, and harm reduction strategies should be informed by a detailed understanding of the extent and nature of that harm. Drug harm is also context specific, and so any comprehensive assessment of drug harm should be relevant to the characteristics of the population in question. This study aimed to evaluate and rank drug harms within Aotearoa New Zealand using a multi-criteria decision analysis (MCDA) framework, and to separately consider harm within the total population, and among youth.

METHODS

Two facilitated workshops involved the separate ranking of harm for the total population, and then for youth aged 12-17, by two expert panels. In the total population workshop, 23 drugs were scored against 17 harm criteria, and those criteria were then evaluated using a swing weighting process. Scoring and weighting were subsequently updated during the youth-specific workshop. All results were recorded and analysed using specialised MCDA software.

RESULTS

When considering overall harm, the MCDA modelling results indicated that alcohol, methamphetamine and synthetic cannabinoids were the most harmful to both the overall population and the youth, followed by tobacco in the total population. Alcohol remained the most harmful drug for the total population when separately considering harm to those who use it, and harm to others.

CONCLUSIONS

The results provide detailed and context-specific insight into the harm associated with psychoactive drugs use within Aotearoa New Zealand. The findings also demonstrate the value of separately considering harm for different countries, and for different population subgroups.

Harms associated with inhalant misuse in adolescent females - a review of the pre-clinical and clinical evidence

BACKGROUND

Inhalant misuse, or the misuse of products containing toluene is common in adolescents, and is associated with diverse physiological and psychological harms. Females comprise over half those who misuse inhalants in adolescence, however, the majority of the evidence has been derived from male-only or mixed-sex studies without exploration of sex differences. Female adolescence is a critical maturational period with potential for growth, reproductive, cognitive and psychological harms that may lead to long-term health consequences. We therefore summarise evidence of female-specific harms arising from inhalant misuse.

METHODS

We synthesised pre-clinical and clinical studies of inhalant misuse which were conducted in females, or where sex-differences were reported, into a narrative literature review.

RESULTS

Females experience growth impairments and metabolic dysfunction arising from inhalant misuse, but data on sex-differences are inconclusive. Inhalant misuse in early adolescence may impact menarche and subsequent reproductive capacity, but studies have predominantly focused on the effects of inhalants on offspring rather than on the exposed female. There is limited evidence of sex-differences in relation to cognitive outcomes following exposure to inhalants in pre-clinical models. Females are at an increased risk of psychological harms associated with inhalant misuse, particularly depression and suicidal behaviour.

CONCLUSIONS

The type and magnitude of harms associated with inhalant misuse are sex-specific, but data are limited. We recommend that both pre-clinical and clinical studies of inhalant misuse include both males and females, and should specifically test for and report sex-differences. This can be used to build an evidence base for screening and interventions tailored to females.

Cardiac arrest by inhalation of deodorant spray

Drug abuse by inhalation of volatile household product substances is uncommon, however, it can have devastating consequences. This case report describes the fatal outcome of deodorant inhalation by a 19-year-old patient in a detoxification clinic who developed a cardiac arrest after inhaling butane from a deodorant spray. Despite initial successful resuscitation, he developed a postanoxic encephalopathy with a status epilepticus resistant to extensive treatment. Inhalant abuse can be a cause of death in young patients.

Adolescent inhalant abuse leads to other drug use and impaired growth; implications for diagnosis

OBJECTIVE

Abuse of inhalants containing the volatile solvent toluene is a significant public health issue, especially for adolescent and Indigenous communities. Adolescent inhalant abuse can lead to chronic health issues and may initiate a trajectory towards further drug use. Identification of at-risk individuals is difficult and diagnostic tools are limited primarily to measurement of serum toluene. Our objective was to identify the effects of adolescent inhalant abuse on subsequent drug use and growth parameters, and to test the predictive power of growth parameters as a diagnostic measure for inhalant abuse.

METHODS

We retrospectively analysed drug use and growth data from 118 Indigenous males; 86 chronically sniffed petrol as adolescents.

RESULTS

Petrol sniffing was the earliest drug used (mean 13 years) and increased the likelihood and earlier use of other drugs. Petrol sniffing significantly impaired height and weight and was associated with meeting 'failure to thrive' criteria; growth diagnostically out-performed serum toluene.

CONCLUSIONS

Adolescent inhalant abuse increases the risk for subsequent and earlier drug use. It also impairs growth such that individuals meet 'failure to thrive' criteria, representing an improved diagnostic model for inhalant abuse. Implications for Public Health: Improved diagnosis of adolescent inhalant abuse may lead to earlier detection and enhanced health outcomes.

Recreational inhalation of butane and propane in adolescents: Two forensic cases of accidental death

The recreational use of inhalants is a fairly widespread habit among adolescents because of the ease of availability and methods of assumption. Their use is however not free of risks, both for direct toxicity on several target organs and for a mechanism of gas replacement with lack of oxygen. The first case concerns a 12-year-old boy who died suddenly after sniffing a mix of butane and propane contained in a can of air freshener. The second case concerns a 14-year-old boy who died by acute poisoning by the same mixture contained in a refill for lighters. High concentrations of the compounds were found in the tissues by analysis with gas chromatography-mass spectrometry. The compounds found in tissues and biological fluids were perfectly compatible with those contained in the containers used for the inhalation. The mechanisms of death were therefore assessed in a combination of the direct toxicity of the compound and oxygen replacement, thus highlighting the crucial help that toxicological analyses can provide in such cases.

“It Might Be a Scummy-Arsed Drug but it's a Sick Buzz”: Chroming and Pleasure

Arguing that the role of pleasure in young people's decisions to use inhalants has been underexplored, this paper provides a typology for the kinds of pleasurable experience young people report from chroming (an Australian term for inhalant use involving aerosol paints). The paper draws on in-depth interviews with young people with experience of chroming and with expert workers in Melbourne, Australia. Seven categories of pleasurable experience related to chroming are identified through thematic analysis of these interviews: feeling, escaping and relocating, imagining, doing, socializing, communicating, and consuming. In the context of use by marginalized young people, chroming has powerful and often deeply pleasurable effects. Understanding more about the kinds of enjoyment that young people seek and experience through chroming—and by implication what workers are asking them to give up when they try to make them stop using these drugs—is important in designing policy interventions.

Multianalytical Method Validation for Qualitative and Quantitative Analysis of Solvents of Abuse in Oral Fluid by HS-GC/MS

The use of oral fluid as a biological matrix to monitor the use of drugs of abuse is a global trend because it presents several advantages and good correlation to the blood level. Thus, the present work aimed to develop and validate an analytical method for quantification and detection of solvents used as inhalants of abuse in oral fluid (OF), using Quantisal™ as collector device by headspace and gas chromatography coupled with a mass detector (HS-GC/MS). Chromatographic separation was performed with a ZB-BAC1 column and the total time of analysis was 11.8 min. The method showed good linearity (correlation coefficient higher than 0.99 for all solvents). The limits of detection ranged from 0.05 to 5 mg/L, while the lower limits of quantification ranged from 2.5 to 12.5 mg/L. Accuracy, precision, matrix effect, and residual effect presented satisfactory results, meeting the criteria accepted for the validation of bioanalytical methods. The method showed good selectivity considering that, for solvents coeluting at the same retention time, resolution was performed by the mass detector. The method developed proved to be adequate when applied in OF samples from users of drugs and may be used to monitor the abuse of inhalants in routine forensic analyses.

Long-Term Prevalence and Demographic Trends in U.S. Adolescent Inhalant Use: Implications for Clinicians and Prevention Scientists

BACKGROUND

Inhalant use by adolescents is cause for concern due to the early age of inhalant use initiation and the many short- and long-term health consequences that can occur concurrently with and subsequent to use. However, inhalant use research has been limited relative to the literature available on other drug use.

OBJECTIVES

The present research examined long-term trends in inhalant use prevalence, demographic risk factors of inhalant use, and median grade level of first use.

METHODS

Monitoring the Future data from 1991 to 2011, which includes information drawn from United States eighth, tenth, and twelfth graders, were examined. The total sample comprised more than one million participants. Results were examined descriptively with figures and quantitatively with mixed-effects regression models of the effect of time on use rates.

RESULTS

Inhalant use prevalence rates generally declined over the selected period. Though rates of use by males and females decreased significantly, the proportion of females among lifetime users increased significantly. Whites, Hispanics, and members of uncategorized "other" ethnicities showed the highest prevalence rates. Although the proportion of Whites among lifetime users decreased significantly, the proportion of Hispanics and "other" ethnicities increased significantly. The median first use was between sixth and ninth grade.

CONCLUSIONS/IMPORTANCE

Results suggest a need to tailor inhalant use treatment and prevention programs to the needs of specific demographic groups and to target interventions early to prevent youth inhalant use. Strengths, limitations, and directions for future research are discussed.

Does DSM-5 nomenclature for inhalant use disorder improve upon DSM-IV?

Among drug classes, substance use disorder (SUD) consequent to using inhalants (SUD-I) has perhaps the smallest evidence base. This study compared DSM-IV versus DSM-5 nomenclatures, testing whether 4 traditional categories of inhalants (aerosols, gases, nitrites, solvents) are manifestations of a single pathology, obtaining item parameters of SUD-I criteria, and presenting evidence that SUD can result from using nitrites. An urban, Midwestern, community sample of 162 inhalant users was recruited. Participants were 2/3 male, nearly 85% White, and had a mean age of 20.3 years (SD = 2.4 years), spanning the ages of greatest incidence of SUD and slightly older than the primary ages of inhalants use initiation. Analyses consisted of bivariate associations, principle components analysis, and item response theory analysis. Validity was demonstrated for SUD-I consequent to each inhalant type as well as for aggregating all inhalant types into a single drug class. Results supported DSM-5 nomenclature over DSM-IV in multiple ways except that occurrence of diagnostic orphans was not statistically smaller using DSM-5. (PsycINFO Database Record

Altered states: psychedelics and anesthetics

The psychedelic experience has been reported since antiquity, but there is relatively little known about the underlying neural mechanisms. A recent neuroimaging study on psilocybin revealed a pattern of decreased cerebral blood flow and functional disconnections that is surprisingly similar to that caused by various anesthetics. In this article, the authors review historical examples of psychedelic experiences induced by general anesthetics and then contrast the mechanisms by which these two drug classes generate altered states of consciousness.

Demographic and contextual factors associated with inhalant use among youth in rural Alaska

Background

Abuse of harmful legal products that can be inhaled or ingested is a serious and growing problem in many rural Alaskan communities, and particularly so among preteens.

Methods

This study analyses data collected during baseline measurements of a 5-year NIH/NIDA-funded study entitled A Community Trial to Prevent Youth's Abuse of Harmful Legal Products in Alaska. Youth in 8 communities located throughout the state participated in a survey during the fall of 2009 to measure the prevalence and availability of harmful legal products (n=697). The goal of the analysis presented here is to compare the contextual factors of inhalant users and non-users in rural Alaskan communities.

Results

As reported in national surveys of substance use among youth, participants in this study indicated using alcohol more than any other substance. Inhalants were the second-most common substance abused, higher than either cigarettes or marijuana. Lifetime use varied among demographic factors such as age, gender and ethnicity as well as contextual factors including academic performance, parent employment, household living situation and income. When compared to non-users, significantly larger proportions of participants reporting lifetime inhalant use indicated easy availability of inhalants in their home, school and retail outlets. Users were also significantly more likely than non-users to have consumed alcohol.

Conclusion

Results of this study may inform the development of effective interventions in other rural communities.

Cognitive recovery during and after treatment for volatile solvent abuse

BACKGROUND

Cognitive impairment reflecting CNS disruption in chronic solvent abusers can resolve within two years of abstinence. However, the specific time course for recovery has yet to be determined empirically. This study monitored cognition among solvent (i.e., gasoline) abusers throughout 8 weeks of residential treatment. It also investigated the extent to which solvent-related cognitive impairments persisted following discharge.

METHODS

Non-drug using healthy controls (n=33) and solvent abusers (n=29) who had inhaled gasoline, regularly or episodically, for an average of 4.3 years (SD=2.7) were assessed. Using linear mixed model analyses, solvent abusers were compared to healthy controls throughout treatment at baseline, two weeks, four weeks and six weeks, on visual motor, attention, learning, memory, and executive function tasks. Ten users who maintained abstinence were reassessed an average of 12 months later (SD=2.8) and were compared to healthy controls (n=12) retested at the same time interval using ANCOVA while controlling for age and baseline performance.

RESULTS

At baseline, solvent abusers showed cognitive deficits on visual motor, learning and memory, paired associate learning, and executive functions. Paired associate learning performance improved within 6 weeks of abstinence, however, impairments in visual motor speed, learning and memory, and executive function persisted throughout and in some cases beyond treatment.

CONCLUSIONS

Cognitive deficits exist for solvent abusers upon treatment entry. Some impairments resolve within weeks of abstinence, while memory and executive function improves gradually over months to years of abstinence, and might never fully recover.

Reported survival with severe mixed acidosis and hyperlactemia after toluene poisoning

Lactic acidosis is a recognized complication of the inhalant abuse such as toluene, especially in patients with renal insufficiency. We report a case of severe metabolic acidosis and hyperlactemia due to toluene sniffing. The favorable outcome, despite extremely poor clinical symptoms, signs, laboratory and radiological findings, was unexpected. Specific aspects of the clinical course are addressed. Toluene sniffing should be considered in evaluating sever metabolic acidosis. Favorable outcome could be achieved with early diagnosis and proper interventions.

Baclofen in the management of inhalant withdrawal: a case series

INTRODUCTION

Abuse of inhalants and solvents is a significant public health problem. There is no specific treatment for inhalant withdrawal.

OBJECTIVE

To study the effect of baclofen in treating craving and withdrawal symptoms in patients with inhalant dependence.

CASE REPORTS

Case studies of 3 young male patients with DSM-IV diagnoses of inhalant dependence treated in an inpatient setting with baclofen are presented. All patients had nonspecific withdrawal symptoms in the form of irritability, insomnia, and craving. Baclofen was given in doses up to 50 mg/day and was continued throughout the period of hospitalization.

DISCUSSION

All patients reported significant reduction in withdrawal symptoms within 48 hours of treatment and were free of symptoms for the duration of their hospital stay. One patient continued the medication as an outpatient and has remained abstinent to date. Baclofen was well tolerated by all patients. Our results suggest that baclofen may be an effective treatment modality in this patient population. These effects are possibly due to the agonistic action of baclofen at gamma-aminobutyric acid B receptors in the ventral tegmental area.

The prevalence and clinical significance of inhalant withdrawal symptoms among a national sample

Background

Inhalants are among the most common and dangerous forms of substance use, but very little research on inhalant use disorders exist. Unlike other substances, the Diagnostic and Statistical Manual, 4th edition (DSM-IV) indicates that inhalants do not have an associated withdrawal syndrome among persons who meet criteria for inhalant dependence.

Methods

Using data from the National Epidemiologic Survey on Alcohol and Related Conditions, this study examines the prevalence of withdrawal symptoms among inhalant users. Prevalence of inhalant withdrawal symptoms for inhalants was also compared with the prevalence of cocaine withdrawal symptoms to help determine the presence of an inhalant withdrawal syndrome.

Results

Approximately 47.8% of persons who met criteria for inhalant dependence reported experiencing three or more inhalant-related withdrawal symptoms that were clinically significant. Among those with inhalant dependence, almost half of the withdrawal symptoms were as common as the corresponding withdrawal symptoms experienced by persons with cocaine dependence. Furthermore, the percentage of persons with inhalant dependence reporting clinically significant inhalant withdrawal symptoms was almost equal to the percentage of persons with cocaine dependence reporting clinically significant cocaine withdrawal symptoms.

Conclusions

These data provide evidence for an inhalant-related withdrawal syndrome among persons with inhalant dependence. Revisions to DSM-IV should consider including inhalant withdrawal as a diagnostic criterion for this disorder.

The dark side of sniffing: paint colour affects intoxication experiences among adolescent inhalant users

INTRODUCTION AND AIMS

Inhalant abuse among adolescents is a significant health concern in many countries; however, limited research has explored whether the intoxication experience differs between commonly used inhalants. The aim of the present study was to examine how exposure to different types of paints (chrome vs. non-chrome) were experienced by adolescent users.

DESIGN AND METHODS

Sixteen adolescent (aged 15-19 years) regular inhalant users completed a semistructured questionnaire enquiring about their inhalant use. Participants were divided into two groups based on paint colour preference [chrome paints (n = 10) and non-chrome paints (n = 6)] and were compared using appropriate statistical tests.

RESULTS

Relative to non-chrome users, the chrome-using group were more likely to report deliberately inhaling to experience altered perceptions (such as visual and auditory hallucinations). In addition, a significantly greater proportion of chrome users reported that the perceptual alterations they experienced after sniffing paint differed between paint colours, with chrome colours being associated with more vivid hallucinations.

DISCUSSION AND CONCLUSION

While both chrome and non-chrome users reported a comparable level of pleasure from paint sniffing, chrome paint users were more likely to be motivated by the potential to hallucinate. Our findings suggest that the type of inhalant used is an important consideration that may have relevance to clinical treatment.

Item response theory analysis of DSM-IV criteria for inhalant-use disorders in adolescents

OBJECTIVE

Inhalants are a serious public health concern and a dangerous form of substance use. An important unresolved issue in the inhalant literature concerns the validity of inhalant-use diagnoses and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, distinction between inhalant abuse and inhalant dependence. To address these limitations and provide the foundation for helping build stronger diagnostic and assessment tools related to inhalant problems, this study examined the dimensionality of the criteria set and the abuse-dependence distinction using item response theory (IRT) analysis.

METHOD

This study used data from a survey of the population of Missouri Division of Youth Services' residents of the residential treatment system. The current study focused on adolescents and young adults who reported a lifetime history of inhalant use (N = 279).

RESULTS

The results from the IRT analysis showed no consistent hierarchical ordering of abuse and dependence criteria, providing strong evidence against the abuse-dependence distinction. The abuse criterion of legal problems associated with use represented the item with the highest level of inhalant severity. The dependence criterion that was related to giving up important social, occupational, or recreational activities provided the most accurate discrimination between individuals at different levels of severity.

CONCLUSIONS

Inhalant-use disorders are best represented using a dimensional versus a categorical approach. IRT analysis provides guidance for selecting criteria that can be useful for brief assessments of inhalant-use problems.

Solvent-induced leukoencephalopathy: a disorder of adolescence?

Volatile substance misuse is common during early adolescence; however, limited work has been conducted investigating the neurobiological effects of such use on the developing brain. While both animal and human studies report cognitive and neurobiological harm associated with volatile substance misuse during adolescence (particularly involving white matter structures), the complex psychosocial characteristics of volatile substance misusers confound the specificity of reported volatile substance-related pathology in human subjects. In addition, few studies have examined whether cognitive and neurobiological recovery occurs with abstinence, although there is some literature indicating that neurological and cognitive improvement is possible, but relates to the frequency and duration of previous use. Longitudinal studies utilizing well-matched control samples are required to fully delineate the short- and long-term impact of volatile substance misuse on adolescent brain development.

Homeostatic control of neural activity: a Drosophila model for drug tolerance and dependence

Drug addiction is a complex condition of compulsive drug use that results in devastating physical and social consequences. Drosophila melanogaster has recently emerged as a valuable genetic model for investigating the mechanisms of addiction. Drug tolerance is a measurable endophenotype of addiction that can be easily generated and detected in animal models. The counteradaptive theory for drug dependence postulates that the homeostatic adaptations that produce drug tolerance become counteradaptive after drug clearance, resulting in symptoms of dependence. In flies, a single sedation with ethanol or with an organic solvent anesthetic (benzyl alcohol) induces functional tolerance, an adaptation of the nervous system that reduces the effect of these neural depressants. Here we review the role of the BK channel gene (slo) and genes that encode other synaptic proteins in the process of producing functional tolerance. These proteins are predicted to be part of an orchestrated response that involves specific interactions across a highly complex synaptic protein network. The response of the slo gene to drug exposure and the consequence of induced slo expression fit nicely the tenets of the counteradaptive theory for drug tolerance and dependence. Induction of slo expression represents an adaptive process that generates tolerance because it enhances neuronal excitability, which counters the sedative effects of the drugs. After drug clearance, however, the increase in slo expression leads to an allostatic withdrawal state that is characterized by an increase in the susceptibility for seizure. Together, these results demonstrate a common origin for development of drug tolerance and withdrawal hyperexcitability in Drosophila.

Volatile substance misuse in the United States

Volatile substance misuse (VSM) is prevalent in the United States and associated with manifold deleterious outcomes. This review summarizes research on: (1) the prevalence of VSM in the United States and its trends since 1975, (2) population subgroups at an elevated risk for VSM, (3) key correlates of VSM, (4) psychosocial consequences of VSM, including emerging public health threats, and (5) etiological and contextual considerations of VSM use. Implications for future research and practice with volatile substance misusers in the United States are identified.

The latest evidence in the neuroscience of solvent misuse: an article written for service providers

This work reviews preclinical and clinical studies published during the past two decades on the cellular and behavioral effects of commonly misused solvents. In animals, acute solvent exposure produces motor impairment and antidepressant- and anxiolytic-like effects. Human intoxication from misusing solvents is similar to that of ethanol; however, hallucinations and sudden sniffing death may occur at high solvent concentrations. Among chronic misusers, there is evidence of impaired memory, increased prevalence of psychiatric disorders, and neurological damage. Solvents facilitate inhibitory neurotransmission and block excitatory mechanisms. Toluene, in particular, increases brain dopamine levels and its effects occur at concentrations that do not dissolve cell membranes; therefore, neuronal damage is not an immediate, unavoidable consequence of solvent misuse.

Recovery from central nervous system changes following volatile substance misuse

This review examines cognitive, neurological, and neuroanatomical recovery associated with abstinence from volatile substance misuse (VSM). Articles describing functional or structural brain changes longitudinally or cross-sectional reports comparing current and abstinent users were identified and reviewed. A significant lack of empirical studies investigating central nervous system recovery following VSM was noted. The few case reports and group studies identified indicated that cognitive and neurological impairments appear to follow a progression of decline and progression of recovery model, with the severity of impairment related to the duration and severity of misuse, blood lead levels among leaded petrol misusers, and the duration of abstinence for recovery. By contrast, severe neurological impairment known as lead encephalopathy from sniffing leaded petrol occurred as more catastrophic or abrupt damage to cerebellar processes that may never fully recover. Neuroanatomical damage may not recover even with prolonged abstinence.

Glue Sniffing: A Review

Inhalant abuse is a prevalent and often overlooked form of substance abuse in adolescents and young adults. It causes a euphoric feeling, may become addictive and can be a serious health concern associated with significant morbidity and mortality. Acute effects of inhalants include sudden sniffing death syndrome, asphyxia, and traumatic injuries. Chronic inhalant abuse can damage the brain, heart, lung, kidney, liver, and bone marrow in addition to being an important cause of psychosocial and economic problems. This article is proposed to emphasize on the harmful effects of glue-sniffing, its prevention and management.

Executive control among adolescent inhalant and cannabis users

INTRODUCTION AND AIMS

Inhalants are frequently among the first drugs abused by adolescents; however, little is known about how chronic inhalant abuse affects cognition (e.g. executive functioning). Several studies have examined cognitive deficits among inhalant users; however, no study has thoroughly addressed the confounding issues frequently associated with inhalant users (e.g. polysubstance use). The aim of the current study was to examine possible deficits in cognitive control among young, regular inhalant users and explore the relationship between inhalant use and executive functioning.

DESIGN AND METHODS

Three groups (n = 19) of young people (aged 14-24) were recruited: an inhalant-using group, a drug-using control group and a community control group. The inhalant and drug-using controls were matched on demographic, clinical and substance use measures. All three groups were matched on age, sex and education. Cognitive control was assessed using Stroop and Go/No-Go tasks.

RESULTS

There were no significant differences in performance between the groups on any measure. However, three measures (incongruent reaction times and congruent errors for the Stroop and omission errors for the Go/No-Go) were significantly correlated with inhalant use measures, suggesting inhalant use was associated with poorer performance.

DISCUSSION AND CONCLUSIONS

The lack of significant differences between the groups is surprising; however, it raises important questions regarding cognitive deficits among chronic inhalant users. Further longitudinal studies using well-matched control participants are required to delineate the nature and timing of cognitive and neurobiological pathology among adolescent inhalant users.

The mysterious practice of petrol sniffing in isolated indigenous groups

The practice of petrol sniffing is a unique and poorly understood phenomenon that is associated with substantial morbidity, mortality and social devastation in affected remote Indigenous communities. For these groups and for the wider community, much mystery has surrounded the practice and its effects. Here we introduce the epidemiology of petrol sniffing among Indigenous groups internationally, review its impact on the brain, behaviour and social functions and summarise related interventions.

Increased risk for hepatitis C associated with solvent use among Canadian Aboriginal injection drug users

Background

Solvent abuse is a particularly serious issue affecting Aboriginal people. Here we examine the association between solvent use and socio-demographic variables, drug-related risk factors, and pathogen prevalence in Aboriginal injection drug users (IDU) in Manitoba, Canada.

Methods

Data originated from a cross-sectional survey of IDU from December 2003 to September 2004. Associations between solvent use and variables of interest were assessed by multiple logistic regression.

Results

A total of 266 Aboriginal IDU were included in the analysis of which 44 self-reported recent solvent use. Hepatitis C infection was 81% in solvent-users, compared to 55% in those reporting no solvent use. In multivariable models, solvent-users were younger and more likely to be infected with hepatitis C (AOR: 3.5; 95%CI: 1.3,14.7), to have shared needles in the last six months (AOR: 2.6; 95%CI:1.0,6.8), and to have injected talwin & Ritalin (AOR: 10.0; 95%CI: 3.8,26.3).

Interpretation

High hepatitis C prevalence, even after controlling for risky injection practices, suggests that solvent users may form closed networks of higher risk even amongst an already high-risk IDU population. Understanding the social-epidemiological context of initiation and maintenance of solvent use is necessary to address the inherent inequalities encountered by this subpopulation of substance users, and may inform prevention strategies for other marginalized populations.

Inhalant withdrawal as a clinically significant feature of inhalant dependence disorder

Inhalant use is the intentional inhalation of vapors from commercial products or specific chemical agents for the purpose of achieving intoxication. Inhalants are among the most common and pernicious forms of substance use and the least studied of the major drugs. Diagnosis of inhalant dependence, according to the DSM-IV [Weintraub E, Gandhi D, Robinson C. Medical complications due to mothball abuse. South Med J 2000;93:427-9] excludes inhalant withdrawal symptoms, as expert opinion has suggested that an inhalant withdrawal syndrome is neither common nor clinically significant. This article draws from multiple sources of data to suggest that withdrawal symptoms can be part of inhalant dependence and are clinically significant. This hypothesis needs rigorous evaluation to ensure the diagnostic validity of inhalant use disorders.

Prevalence, timing, and predictors of transitions from inhalant use to inhalant use disorders

BACKGROUND

Few studies of the natural history of DSM-IV inhalant substance use disorders (I-SUDs) have been conducted. This investigation examined the prevalence, timing, and predictors of transitions from inhalant use to formal I-SUDs among inhalant users within a nationally representative sample.

METHODS

Participants were 664 U.S. residents participating in the 2000-2001 National Epidemiologic Survey on Alcohol and Related Conditions who reported lifetime inhalant use. Respondents completed structured interviews assessing DSM-IV psychiatric/substance use disorders. Bivariate and Cox regression analyses were conducted to identify risk factors for transitions from inhalant use to I-SUDs.

RESULTS

Nearly one in five (19.4%) persons initiating inhalant use developed an I-SUD. Most I-SUD transitions were to inhalant abuse rather than inhalant dependence. Risk for development of I-SUDs was greatest in the first year following initiation of inhalant use and low thereafter. Multivariate proportional hazards models indicated that presence of a mood/anxiety disorder (HR=7.7, CI=3.1-18.9) or alcohol use disorder (HR=11.9, CI=5.46-26.00) antedating initiation of inhalant use predicted significantly elevated risk for I-SUDs, whereas being married conferred a lower risk for onset of I-SUDs.

CONCLUSIONS

I-SUDs were relatively common among inhalant users, generally occurred in the year following initiation of inhalant use, and were associated with early-onset mood/anxiety and alcohol use disorders. Given the young average age at onset of inhalant use and the rapidity with which most I-SUDs developed, interventions directed to adolescents who have initiated inhalant use might be effective in reducing the proportion of inhalant users who develop I-SUDs.

"...you would probably want to do it. Cause that's what made them popular": Exploring perceptions of inhalant utility among young adolescent nonusers and occasional users

With an eye toward future primary prevention efforts, this study explores perceptions of inhalant utility among young adolescents in the United States. The study makes use of data gathered via nine focus groups conducted in Tucson, Arizona in 2004 (N = 47, mean age = 13.2 years). Three main themes emerged concerning the perceived utility of inhalant use: (1) Inhalant use as a means of mental escape, (2) Inhalant use as a social tool, and (3) Inhalant use as a parental relations tool. Additionally, participants discussed an interaction hypothesis regarding inhalant use and popularity. Implications for future research are suggested and limitations described.

Volatile bodies: Stories of corporeal pleasure and damage in marginalised young people's drug use

BACKGROUND

This paper explores the connection between meaning and corporeal pleasure in drug use experience through considering accounts of inhalant use made by marginalised young people in Melbourne, Australia. Inhalants (also known as volatile substances or solvents) have a reputation internationally as drugs of desperation rather than enjoyment. Corporeal pleasure as a motive for inhalant use is generally overlooked in policy, drug research literature and health education--as is frequently the case also in relation to other forms of drug use practiced by marginalised peoples. In contrast, harms such as brain damage and death are strongly emphasised.

METHODS

Twenty-seven young people with current or past experience of inhalant use were interviewed, each between one and three times. Participants were asked to speak about what they liked and did not like about inhalant use. A narrative analysis was used to identify stories about the bodily encounter with inhalants that were iterated across interview transcripts.

RESULTS

Two narratives about corporeal experiences of inhalant-induced intoxication are discussed here, both of which research participants framed within an understanding of these drugs as pre-eminently dangerous. The first narrative is that inhalant use is an ineffable experience of the body. The second links the intensity of pleasure occasioned by inhalant use with the infliction of brain damage and risk of death.

CONCLUSION

Catastrophic beliefs about the dangers associated with inhalant use serve in some instances to accentuate the pleasures it affords users, and at the same time debilitate their sense of capacity to change. Additionally, where drug users are depicted as self-harming rather than seekers of (albeit risky) pleasure, the range of policy options likely to be implemented is restricted. Education provided through drug treatment presents an opportunity to counter some of the harms associated with narratives of pleasure and damage in drug use.

Influencing inhalant intentions by changing socio-personal expectations

This study investigates an approach for reducing inhalant initiation among younger adolescents: altering Socio-Personal Expectations (SPEs), a term referring to perceived linkages between behavior and personally relevant social outcomes. The study focuses specifically on SPEs regarding outcomes associated with increased social status and popularity. An anti-inhalant message was embedded within a short anti-bullying education video. Young adolescents (N=893) were assigned randomly to receive a message focused on the physical or the social harms of inhalant use. The objectives of this study were to test: (1) the malleability of SPEs, (2) SPEs' predictive validity for future inhalant use, and (3) whether being exposed to a socio-personal threat, rather than a physical threat, led to different variables affecting drug-relevant decision-making processes. Analysis of variance suggested the malleability of SPEs (p< .001). Multiple regression analysis revealed that SPEs were predictive of future inhalant use. SPEs accounted for a significant portion of variance in future intentions over and above demographic variables, prior use, psychosocial variables, and perceived physical harm (R(2)= .26, p< .01). Moreover, being exposed to a social, rather than a physical threat, message resulted in different variables being predictive of future intentions to use inhalants.

Inhalant abuse among adolescents: neurobiological considerations

Experimentation with volatile substances (inhalants) is common during early adolescence, yet limited work has been conducted examining the neurobiological impact of regular binge use during this key stage of development. Human studies consistently demonstrate that chronic use is associated with significant toxic effects, including neurological and neuropsychological impairment, as well as diffuse and subtle changes in white matter. However, most preclinical research has tended to focus on acute exposure, with limited work examining the neuropharmacological or toxicological mechanisms underpinning these changes or their potential reversibility with abstinence. Nevertheless, there is growing evidence that commonly abused inhalants share common cellular mechanisms, and have similar actions to other drugs of abuse. Indeed, the majority of acute behavioural effects appear to be underpinned by changes in receptor and/or ion channel activity (for example, GABA(A), glycine and 5HT(3) receptor activation, NMDA receptor inhibition), although nonspecific interactions can also arise at high concentrations. Recent studies examining the effects of toluene exposure during the early postnatal period are suggestive of long-term alterations in the function of NMDA and GABA(A) receptors, although limited work has been conducted investigating exposure during adolescence. Given the critical role of neurotransmitter systems in cognitive, emotional and brain development, future studies will need to take account of the substantial neuromaturational changes that are known to occur in the brain during childhood and adolescence, and to specifically investigate the neuropharmacological and toxicological profile of inhalant exposure during this period of development.

Necrotizing leukoencephalopathy following CHOP chemotherapy

Toxic leukoencephalopathy syndromes are rare disorders of cerebral injury characterized by changes in the white matter and accompanying neurologic dysfunction. They have been reported in association with a variety of clinical etiologies, most commonly including severe hypertension, cranial irradiation, and environmental toxins. However, they have also been described in conjunction with immunosuppressive and chemotherapeutic agents. There has been one case of fatal leukoencephalopathy reported following CHOP chemotherapy for non-Hodgkin lymphoma. We report a second case of fatal necrotizing leukoencephalopathy following the administration of CHOP chemotherapy.

Toluene misuse and long-term harms: a systematic review of the neuropsychological and neuroimaging literature

Organic solvent abuse is associated with increased risk for serious medical, neurological, and neuropsychological impairments. While animal research suggests that exposure to organic solvents (especially toluene) may be neurotoxic, much less is known about the consequences of long-term exposure in humans. We reviewed neuroimaging and neuropsychological studies examining chronic toluene misuse in humans. Thirty empirical studies fulfilled the inclusion and exclusion criteria, including case studies (n=9) as well as group studies with (n=11) and without a control group (n=10). Our review indicates that toluene preferentially affects white matter (relative to gray matter) structures and periventricular/subcortical (relative to cortical) regions. The lipid-dependent distribution and pharmacokinetic properties of toluene appears to explain the pattern of MRI abnormalities, as well as the common symptoms and signs of toluene encephalopathy. The commonly observed neuropsychological deficits such as impairments in processing speed, sustained attention, memory retrieval, executive function and language, are also consistent with white matter pathology. We discuss the implications of these findings in the context of a neurodevelopmental framework, as well as the neuropathology and pathophysiology of toluene abuse. We also propose a set of recommendations to guide future research in this area.

Glutamatergic substrates of drug addiction and alcoholism

The past two decades have witnessed a dramatic accumulation of evidence indicating that the excitatory amino acid glutamate plays an important role in drug addiction and alcoholism. The purpose of this review is to summarize findings on glutamatergic substrates of addiction, surveying data from both human and animal studies. The effects of various drugs of abuse on glutamatergic neurotransmission are discussed, as are the effects of pharmacological or genetic manipulation of various components of glutamate transmission on drug reinforcement, conditioned reward, extinction, and relapse-like behavior. In addition, glutamatergic agents that are currently in use or are undergoing testing in clinical trials for the treatment of addiction are discussed, including acamprosate, N-acetylcysteine, modafinil, topiramate, lamotrigine, gabapentin and memantine. All drugs of abuse appear to modulate glutamatergic transmission, albeit by different mechanisms, and this modulation of glutamate transmission is believed to result in long-lasting neuroplastic changes in the brain that may contribute to the perseveration of drug-seeking behavior and drug-associated memories. In general, attenuation of glutamatergic transmission reduces drug reward, reinforcement, and relapse-like behavior. On the other hand, potentiation of glutamatergic transmission appears to facilitate the extinction of drug-seeking behavior. However, attempts at identifying genetic polymorphisms in components of glutamate transmission in humans have yielded only a limited number of candidate genes that may serve as risk factors for the development of addiction. Nonetheless, manipulation of glutamatergic neurotransmission appears to be a promising avenue of research in developing improved therapeutic agents for the treatment of drug addiction and alcoholism.

The effects of inhaled acetone on place conditioning in adolescent rats

INTRODUCTION

Acetone is an ubiquitous ingredient in many household products (e.g., glue solvents, air fresheners, adhesives, nail polish, and paint) that is putatively abused; however, there is little empirical evidence to suggest that acetone alone has any abuse liability. Therefore, we systematically investigated the conditioned response to inhaled acetone in a place conditioning apparatus.

METHOD

Three groups of male, Sprague-Dawley rats were exposed to acetone concentrations of 5000, 10,000 or 20,000 ppm for 1 h in a conditioned place preference apparatus alternating with air for 6 pairing sessions. A place preference test ensued in an acetone-free environment. To test the preference of acetone as a function of pairings sessions, the 10,000 ppm group received an additional 6 pairings and an additional group received 3 pairings. The control group received air in both compartments. Locomotor activity was recorded by infrared photocells during each pairing session.

RESULTS

We noted a dose response relationship to acetone at levels 5000-20,000 ppm. However, there was no correlation of place preference as a function of pairing sessions at the 10,000 ppm level. Locomotor activity was markedly decreased in animals on acetone-paired days as compared to air-paired days.

CONCLUSION

The acetone concentrations we tested for these experiments produced a markedly decreased locomotor activity profile that resemble CNS depressants. Furthermore, a dose response relationship was observed at these pharmacologically active concentrations, however, animals did not exhibit a positive place preference.